Welcome To The Remembrance Journey...

Dearest One,

This intake supports your participation in The Remembrance Journey.

The Remembrance Journey is a living, guided process of returning to your inner truth and embodied presence. It may unfold through reflective relational work, somatic and spiritual practices, and one-day or multi-phase ceremonial experiences. Some journeys are held without sacrament. Some may include ceremonial or consciousness-based practices. All expressions of the journey are guided with care, reverence, and deep respect for your body, your nervous system, and your lived experience.

The rhythm and shape of your journey are not predetermined. They reveal themselves gently over time, responding to what is alive within you in each moment. What matters most is that the journey remains grounded, consensual, and attuned to your unique pace and needs.

This work is held through trauma-aware, nervous-system-informed, and harm-reduction principles inspired by contemporary research on safe, supported inner exploration. The intention is always to create a container of safety, trust, and presence where your system can soften and remember at its own timing.

By completing this intake, you acknowledge that you are entering a living process rather than a fixed format. Your experience may include different expressions within The Remembrance Journey container, all held with intention, integrity, and care.

Your participation is voluntary. You are always welcome to pause, ask questions, name boundaries, or change consent at any point throughout your journey. You remain the ultimate authority of your own experience.

With love and tenderness,

Staci Michele

How I Work With You...

My work is relational, intuitive, and lovingly attuned to the wholeness of you. Each journey unfolds through deep listening, presence, and respect for your unique way of being.

I weave together astrology, numerology, and Human Design as gentle mirrors. These sacred frameworks offer insight into your natural rhythms, sensitivities, and life patterns, not to define you, but to support a deeper remembering of who you already are.

At the heart of this work lives family systems and Family Constellation informed inquiry. This is the quiet golden thread that guides our time together. Through it, we listen for what has been carried, what may not belong to you, and what is ready to be met with compassion and care.

Our pace is slow and intentional. We honor the wisdom of your body, the truth within your relationships, and the lineage that has shaped your path. When precise information is available, we explore with clarity. When it is not, nothing is missing. We follow patterns, lived experience, and what naturally reveals itself in the moment.

This journey is an invitation into safety, belonging, and embodied truth. It is a gentle return to what feels grounded, alive, and deeply authentic within you.

Your Foundational Information

(Section 1 of 13)

(Accuracy here supports the depth of our work together)

Full Birth Name (Exact Spelling) *

(Please write your full name exactly as it appears on your birth certificate, including middle name(s). If you are unsure of spelling, punctuation, or spacing, please share your best understanding.)

Current Name (if different from birth name) *

Email *

Have you ever been adopted, renamed, or given a different name at birth or later in life? *

Yes

If yes, please share anything you know or feel is relevant.

Which name feels most alive or significant for you in your life right now? *

Date Of Birth *

Time of Birth *

How confident are you in this time of birth? *

If your time is approximate or unknown, please share anything you’ve been told or sense may be helpful. A gentle note on birth timing (for example: early morning, afternoon, evening, around sunrise or sunset) *

Place of Birth *

Current Location *

Before we continue, a gentle note for clarity and care... I understand that this work is reflective, relational, and supportive in nature, and is and is meant to complement, not replace medical, psychological, or therapeutic care. *

I understand and feel comfortable continuing

Your Current Life Season

(Section 2 of 13)

Please share what this season feels like for you, in your own words. *

What feels complete, closing, or gently asking to be released in your life right now? *

What feels unresolved, tender, or quietly asking for your attention? *

Relationships and Lineage

(Section 3 of 13)

Please share anything about your relationship experience that feels relevant or alive for you right now. *

Do you have children? *

Yes

If yes, please share their ages and anything that feels important for me to understand about this part of your life. *

Are there any repeating family patterns, unspoken dynamics, or relational themes that feel present or influential in your life right now? *

(For example: loyalty, responsibility, silence, distance, caretaking, exclusion.)

Your Inner World and Intensions

(Section 5 of 13)

What are you most curious to understand, reconnect with, or clarify within yourself right now? *

What kind of support feels most nourishing for you in this season? *

Gentle reflection and mirroring

Clarity and life orientation

Emotional integration

Spiritual insight

Somatic awareness and embodiment

Relationship support

A safe space to be deeply seen and witnessed

Something else feels supportive for me right now

If you would like to elaborate... Please share what kind of support feels most aligned for you at this time.

If you are holding an intention as you begin this journey, what feels important to name? *

What would help you feel safe, supported, and well-paced as we work together? *

Physical and Medical Safety

(Section 6 of 13)

Do you have any of the following medical or neurological conditions? *Select ALL that apply

Are you currently pregnant or breastfeeding *

Yes

Are you currently taking any medications? If so, please provide a list of them. If not, have you taken any within the past 12 months? (name + dosage): *

Have you taken any prescription medications within the past twelve months? If yes, please provide details. *

Please list any known medical conditions, sensitivities, or allergies we should be aware of. *

Have you ever experienced an adverse reaction to breathwork, meditation, fasting, or intense emotional or somatic practices? If yes, please share. *

Mental and Emotional Wellbeing

(Section 7 of 13)

Have you ever been diagnosed with or experienced symptoms related to the following? *Check ALL that apply

Are you currently receiving support from a psychiatrist, psychologist, coach, or any other mental health professional for your emotional, psychological, or mental well-being? If yes, please share the type of support and whether this provider is aware of your participation in this journey. *

Have you experienced any recent emotional crises, trauma, or destabilizing life events within the past twelve months If yes, please share anything you feel is important for us to know. *

Substance and Sacrament History

(Section 8 of 13)

If your journey does not include sacrament, this information is still requested to support nervous system awareness and safety.

Have you ever worked with altered states of consciousness through ceremony, breathwork, or other spiritual practices? *

Yes

Have you previously worked with entheogens or psychedelic substances? If yes, please share what you worked with and when. *

Have you ever had a challenging or overwhelming experience with altered states or entheogens? If yes, please share how you navigated it and what support was helpful.

Do you currently use substances including cannabis, alcohol, or recreational drugs? If yes, please describe frequency and context. *

Have you ever experienced dependency or addiction related to substances? If yes, please share timeframe and any treatment received. *

Consent For Somatic and Ceremonial Practices

(Section 9 of 13)

This journey may include breathwork, movement, meditation, sound, guided inquiry, emotional processing, or spiritual practices intended to support embodiment and self-awareness.

Please indicate your current consent preferences. These may be changed at any time during your journey.

I consent to safe, intentional touch if guided and agreed upon in the moment. *

I consent to touch only from a same-gender facilitator.

I do not consent to touch at this time.

Are there any areas of your body that you do not feel safe having touched during somatic or body-based work If yes, please specify. *

Are there any emotional, physical, or energetic boundaries you would like us to be aware of? *

Capacity For Stillness and Intensity

(Section 10 of 13)

How do you generally respond to silence, stillness, or deep inward focus? *

Have you participated in silent retreats, extended meditation, or intensive inner work before? If yes, please share briefly. *

What typically helps you return to a sense of safety or grounding when emotions or sensations feel intense? *

Informed Consent and Agreements

(Section 11 of 13)

Please read and affirm the following statements.

I understand that this journey is spiritual and somatic in nature and is not a substitute for medical, psychological, or psychiatric care.

I understand that experiences during this journey may include strong emotions, physical sensations, or altered states of awareness.

I affirm that I am participating voluntarily and take responsibility for my own experience.

I understand that facilitators are trained in trauma-aware, nervous-system-informed, and MAPS-informed harm-reduction principles, and that this journey is guided with care, presence, and respect for consent and pacing.

I release and hold harmless Staci Michele Kessler, Marc Kessler, Reveal Yourself with Grace and Ease, LLC, and all facilitators from liability related to my participation, to the fullest extent permitted by law.

I agree to uphold confidentiality and respect for myself and others if participating in shared or ceremonial space.

I understand that consent is ongoing and may be withdrawn at any time.

By checking this box, I agree to having read and affirm all of the statements provided here as well as in the INFORMED CONSENT, ASSUMPTION OF RISK, AND WAIVER OF LIABILITY.

Final Acknowledgement

(Section 12 of 13)

By typing my full legal name below, I affirm that I have read and understand this intake and consent, that all information provided is accurate to the best of my knowledge, and that I am choosing to participate in this journey freely and with awareness.

Closing

(Section 13 of 13)

Is there anything else you’d like me to know as we begin, or anything you’d like to gently place into this space?

Thank you for your openness and presence. 💝

What you’ve shared here allows me to meet you with care, integrity, and deep respect for your lived experience.

I look forward to our time together.